Barrett's Esophagus

Overview

Barrett’s esophagus is a complication of chronic acid reflux, also known as gastroesophageal reflux disease (GERD). Acid reflux occurs when stomach acid backs up into your esophagus. This frequently results in heartburn and can occasionally cause damage to the lining of the esophagus. Stomach acid can cause damage to your esophagus because the lining in your esophagus is not equipped to protect itself against gastric acid. As the esophagus tries to heal, your cells may change in order to adapt and protect the esophagus. These changes can increase your risk of developing esophageal cancer.

One change that can occur is called metaplasia: the process of the reversible substitution of a distinct kind of cell with another mature cell of another differentiated kind. This occurs when the body starts growing intestinal cells, rather than esophageal cells, in the esophagus because of the acid influx. If the stimulus that caused the metaplasia is removed, tissues can return to their normal pattern of differentiation. If a metaplasia is not addressed in a timely fashion, it can become dysplasia and/or turn cancerous.

Dysplasia comes from the root Greek term meaning “bad formation.” It is the term used to refer to an irregularity that hinders cell maturation within a particular tissue. Dysplasia is the earliest form of pre-cancerous lesions recognizable in a biopsy, and it is typically referred to as low-grade dysplasia or high-grade dysplasia. Low-grade dysplasia means that the cells show small signs of change, while high-grade dysplasia represents a more advanced condition which may progress to esophageal cancer.

Although the risk of esophageal cancer is small, monitoring of Barrett's esophagus focuses on periodic exams to find precancerous esophagus cells. If precancerous cells are discovered, they can be treated, through procedures such as ablation, to prevent esophageal cancer.

Symptoms of Barrett’s esophagus

Frequent heartburn

Difficulty swallowing food

Chest pain

Upper abdominal pain

Dry cough

These symptoms for Barrett’s are similar to acid reflux symptoms; however, many people with Barrett’s have no signs or symptoms.

Risk Factors for Barrett’s esophagus

Chronic heartburn and acid reflux- having these symptoms of GERD for more than 10 years can increase the risk of Barrett’s esophagus

Gender- Men are more likely to develop Barrett’s esophagus

Race- White people have a greater risk of the disease than do people of other races

Age- Barrett’s esophagus is more common in older adults, but it can occur at any age

Tests to Diagnose Barrett’s esophagus

Upper endoscopy- can be performed to diagnose Barrett’s and determine what degree of dysplasia has occurred in your cells. During the procedure, the doctor can examine the esophagus and remove tissue samples for testing.

Treatment for Low-Grade Dysplasia of Barrett’s esophagus

Maintain a healthy weight

Eat smaller, more frequent meals

Avoid tight fitting clothes

Eliminate heartburn triggers

Avoid stooping or bending

Avoid lying down after eating

Raise the head of your bed

Quit smoking

Treatment for High-Grade Dysplasia of Barrett’s esophagus

Surgery to remove the esophagus

Removing damaged cells with an endoscope

Using heat to remove abnormal esophageal tissue

Using cold to destroy abnormal esophagus cells

Destroying damaged cells by making them sensitive to light

If you undergo treatment, other than surgery to remove your esophagus, there is a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.